Common use of Budget Justification and Narrative Clause in Contracts

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1, Required Application Components.) Attachments 1 through 4 – Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments 2. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. Attachment 1: (1) Identification of at least one experienced, licensed mental health/behavioral health services treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; (3) letters of commitment from these direct service provider organizations. Do not include any letters of support. Reviewers will not consider them if you do. (4) the Statement of Assurance (provided in Appendix B of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers meet the two-year experience requirement, are appropriately licensed, accredited and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time. Attachment 2: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. Attachment 3: Sample Consent Forms Attachment 4: Letter to the SSA (if applicable; see PART II: Appendix B, Intergovernmental Review (E.O. 12372) Requirements).

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1Section II-3.1, Required Application Components.) Attachments 1 through 4 7 – Use only the attachments listed below. If your the application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments Attachment 2. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you dothem. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. Attachment 1: (1Letters of Commitment from any organization(s) Identification of at least one experienced, licensed mental health/behavioral health services treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate participating in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; . (3) letters of commitment from these direct service provider organizations. Do not include any letters of support. Reviewers support – it will not consider them jeopardize the review of your application if you do. (4.) the Statement of Assurance (provided in Appendix B of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers meet the two-year experience requirement, are appropriately licensed, accredited and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time. Attachment 2: Data Collection Instruments/Interview Protocols – if you are using the applicant uses standardized data collection instruments/interview protocols, you they do not need to include these in your the application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. Attachment 3: Sample Consent Forms Attachment 4: Letter to the SSA (if applicable; see PART II: Appendix B, C – Intergovernmental Review (E.O. 12372) Requirements). Attachment 5: Non-Federal Funds Match Certification Letter Attachment 6: Strategic Plan, Needs Assessment, or Priority Letter Attachment 7: If applicable, applicants that have a state-level SAMHSA-funded SYT or SYT-I grantee in your state/territory/tribe and have established formal collaborative relationships with them should submit those agreements. At a minimum, the agreement must identify the parties involved; describe the specific roles and responsibilities of each party; include a summary of the essential terms of the agreement; and be signed and dated by the parties involved.

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1, Required Application ComponentsAppendix B – Guidance for Electronic Submission of Applications.) • Attachments 1 through 4 3 – Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 1 and 3 and 4 combined. There are no page limitations for Attachments Attachment 2. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. o Attachment 1: (1Letters of Commitment from any organization(s) Identification of at least one experienced, licensed mental health/behavioral health services treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate participating in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; . (3) letters of commitment from these direct service provider organizations. Do not include any letters of support. Reviewers will not consider them if you do. (4.) the Statement of Assurance (provided in Appendix B of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers meet the two-year experience requirement, are appropriately licensed, accredited and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time. o Attachment 2: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. o Attachment 3: Sample Consent Forms If you are applying as a consortium, you must include “Roles and Responsibilities of Participating National Professional Medical Organizations” in Attachment 4: Letter to 3. These applicants must include a written agreement outlining the SSA (if applicable; see PART II: Appendix B, Intergovernmental Review (E.O. 12372) Requirements)roles and responsibilities of each participating national professional medical organization. This agreement must be signed by an authorized official of each member of the consortium.

Budget Justification and Narrative. The budget justification and narrative must be submitted as file entitled BNF (Budget Narrative Form) when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1Appendix A, 3.1, Required Application Components.) Note that all travel for this program both internationally and regionally must be funded out of grants funds. There are no other travel funds available from SAMHSA for this program. • Attachments 1 through 4 5 – Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments 22 and 5. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label Label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. o Attachment 1: (1Letters of Commitment from any organization(s) Identification of at least one experienced, licensed mental health/behavioral health services treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate participating in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; . (3) letters of commitment from these direct service provider organizations. Do not include any letters of support. Reviewers will not consider them if you do. (4.) the Statement of Assurance (provided in Appendix B of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers meet the two-year experience requirement, are appropriately licensed, accredited and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time. o Attachment 2: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. o Attachment 3: Sample Consent Forms o Attachment 4: Letter Response to Appendix C – Confidentiality and SAMHSA Participant Protection/Human Subjects Guidelines o Attachment 5: Certificate of Eligibility (Appendix J) – Must be included or the SSA (if applicable; see PART II: Appendix B, Intergovernmental Review (E.O. 12372) Requirements)application will be screened out and will not be reviewed.

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1Section II-3.1, Required Application Components.)  Attachments 1 through 4 5– Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments 22 and 5. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. o Attachment 1: (1) Identification of at least one experienced, licensed mental health/behavioral health services treatment experienced substance misuse prevention provider organization; (2) a list of all direct service provider organizations that have agreed to participate in the proposed project, including the applicant agency, agency if it is a treatment or prevention service provider organization; (3) letters of commitment from these direct service provider organizations. ; (Do not include any letters of support. Reviewers will not consider them if you do. .) (4) the Statement of Assurance (provided in Appendix B of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers meet the two-year experience requirement, are appropriately licensed, accredited and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time. o Attachment 2: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. o Attachment 3: Sample Consent Forms o Attachment 4: Letter to the SSA (if applicable; see PART II: Appendix B, Intergovernmental Review (E.O. 12372) Requirements).

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1, Required Application ComponentsAppendix B – Guidance for Electronic Submission of Applications.)  Applicants for this program are required to complete the Assurance of Compliance with SAMHSA Charitable Choice Statutes and Regulations Form SMA 170. This form is posted on SAMHSA’s website at xxxx://xxx.xxxxxx.xxx/grants/applying/forms-resources.  Attachments 1 through 4 5 – Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 3, and 4 combined. There are no page limitations for Attachments 22 and 5. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. o Attachment 1: (1) Identification of at least one experienced, licensed mental health/behavioral health services substance abuse treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; (3) letters of commitment from these direct service provider organizations. organizations (Do not include any letters of support. Reviewers will not consider them if you do. .); (4) the Statement of Assurance (provided in Appendix B II of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that that: a) all listed providers meet the two-year experience requirement, are appropriately licensed, accredited and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time; b) the availability of permanent housing units match the number of individuals to be served in the grant project for each year of the grant; and c) provider treatment organizations are qualified to receive third party reimbursements or have established links to other organizations with existing third party reimbursement systems. o Attachment 2: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. o Attachment 3: Sample Consent Forms o Attachment 4: Letter to the SSA (if applicable; see PART II: Appendix B, C – Intergovernmental Review (E.O. 12372) Requirements).

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1, Required Application ComponentsAppendix B – Guidance for Electronic Submission of Applications.)  Attachments 1 through 4 7 – Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 3, and 4 combined. There are no page limitations for Attachments Attachment 2. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. o Attachment 1: (1Letters of Commitment from any organization(s) Identification of at least one experienced, licensed mental health/behavioral health services treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate participating in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; . (3) letters of commitment from these direct service provider organizations. Do not include any letters of support. Reviewers will not consider them if you do. (4.) the Statement of Assurance (provided in Appendix B of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers meet the two-year experience requirement, are appropriately licensed, accredited and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time. o Attachment 2: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. o Attachment 3: Sample Consent Forms o Attachment 4: Letter to the SSA informing them of the intent to submit an application (if applicable; see PART II: Appendix B, C – Intergovernmental Review (E.O. 12372) Requirements). o Attachment 5: Non-Federal Match Certification Letter from the director of the agency applying for the grant, certifying that matching funds for the proposed project are available and are non-federal funds. o Attachment 6: State or county strategic plan, a state or county needs assessment, or a letter from the state or county indicating that the proposed project addresses a state- or county-identified priority. Tribal applicants must provide similar documentation relating to tribal priorities. o Attachment 7: If applicable, applicants that have a state-level SAMHSA- funded SYT or SYT-I grantee in your state/territory/tribe and have established formal collaborative relationships with them should submit those agreements. At a minimum, the agreement must identify the parties involved; describe the specific roles and responsibilities of each party; include a summary of the essential terms of the agreement; and be signed and dated by the parties involved.

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1Section II-3.1, Required Application Components.)  Applicants for this program are required to complete the Assurance of Compliance with SAMHSA Charitable Choice Statutes and Regulations Form SMA 170. This form is posted on SAMHSA’s website at xxxx://xxx.xxxxxx.xxx/grants/applying/forms-resources.  Attachments 1 through 4 14 – Use only the attachments listed below. Attachments 1-6 are required. Attachments 7-14 are based on your program design, use of EHRs, and selection of infrastructure activities in Section I.2. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments 2Attachments. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. o Attachment 1: (1) Identification of at least one experienced, licensed mental health/behavioral health services treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; (3) letters of commitment from these direct service provider organizations. Do not include any letters of support. Reviewers will not consider them if you do. (4) the Statement of Assurance (provided in Appendix B of this announcement) signed by the authorized representative Authorized Representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers involved with the project will meet the two2-year experience requirement, and are appropriately licensed, accredited accredited, and certified; 2) Applicant Self-Assessment Tool provided in Appendix E of this announcement; your application will be screened out and will not be reviewed if the Applicant Self-Assessment Tool is not included in Attachment 1; and 3) Identification of other organization(s) that will participate in the proposed project, including a description of their roles and responsibilities and letters of commitment from these organizations. o Attachment 2: Written agreement of the Interagency Council. The written agreement must: identify the parties involved in the Council, describe the specific roles and responsibilities of each party, include a summary of the essential terms of the agreement, discuss the Council’s operating procedures, and be signed and dated by the Council’s Lead. The written agreement must be accompanied by: a roster of the Council members that if identifies the application is within the funding range for an awardagency/system that they represent and letters of commitment from, at a minimum, the applicant will send the GPO the required documentation within the specified timesix previously named key collaborating agencies/systems (i.e., State Medicaid Agency, State Health Department, education, criminal/juvenile justice, mental health, and child welfare). o Attachment 23: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 23. o Attachment 34: Sample Consent Forms Forms. o Attachment 5: Financial map of financial resources expended in FY 2011 or later for services for SUD and/or co-occurring substance use and mental disorders (e.g., screening, assessment, treatment, continuing care, recovery support services) for the population of focus. At a minimum, the financial map must consist of tables which: 1) identify screening, assessment, treatment services, and recovery supports needed for a comprehensive continuum of services for adolescents and/or transitional age youth with SUD and/or substance use and co-occurring mental health disorders; 2) identify the federal and state funding sources supporting the provision of these services in a specific fiscal year; 3) identify the federal, state, and aggregate amounts spent from each funding source by service in a specific fiscal year; and 4) identify the number of unique users served through the expenditures in a specific fiscal year, where possible. The tables must be accompanied by service definitions, an acronyms table, and a narrative analyzing findings of the mapping exercise complemented with charts and graphs. o Attachment 6: Letter Workforce Training Implementation Plan - 2015-2017 state-/territorial-/tribal-wide multi-year workforce training implementation plan to provide training in the evidence-based assessment and treatment model as well as training in content and skills related to SUD treatment (e.g., child development, trauma focused treatment, neuroscience) to the SSA specialty adolescent and/or transitional age youth behavioral health (if SUD and/or co-occurring substance use and mental disorder) treatment and recovery workforce. The plan must also include training staff in other agencies serving adolescents and transitional aged youth including primary care on SUD related content (e.g., symptoms of SUD, screening, referral). o Attachment 7: Sustainability Plan - 2017-2020 sustainability plan, which at a minimum, is time framed and discusses key activities, milestones, and responsible staff for implementing the activities encompassed in this project. o Attachment 8: If applicable; see PART II, applicants that select both populations of focus and the responsible lead is housed in two separate entities within the state/territory/tribe, the two entities must collaborate in determining which entity will be the applicant. The two entities must collaborate in carrying out the award requirements, as demonstrated by the submission of signed and dated documentation of each entity’s roles and responsibilities in Attachment 8. o Attachment 9: Appendix BIf applicable, Intergovernmental Review (E.O. 12372) Requirements)applicants that have the State Adolescent Treatment/Youth Coordinator selected at the time of application should include his/her résumé and an employment contract.

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1Section II-3.1, Required Application Components.)  Attachments 1 through 4 7 – Use only the attachments listed below. If your the application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments Attachment 2. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you dothem. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. o Attachment 1: (1Letters of Commitment from any organization(s) Identification of at least one experienced, licensed mental health/behavioral health services treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate participating in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; . (3) letters of commitment from these direct service provider organizations. Do not include any letters of support. Reviewers support – it will not consider them jeopardize the review of your application if you do. (4.) the Statement of Assurance (provided in Appendix B of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers meet the two-year experience requirement, are appropriately licensed, accredited and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time. o Attachment 2: Data Collection Instruments/Interview Protocols – if you are using the applicant uses standardized data collection instruments/interview protocols, you they do not need to include these in your the application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. o Attachment 3: Sample Consent Forms o Attachment 4: Letter to the SSA (if applicable; see PART II: Appendix B, C – Intergovernmental Review (E.O. 12372) Requirements). o Attachment 5: Non-Federal Funds Match Certification Letter o Attachment 6: Strategic Plan, Needs Assessment, or Priority Letter o Attachment 7: If applicable, applicants that have a state-level SAMHSA- funded SYT or SYT-I grantee in your state/territory/tribe and have established formal collaborative relationships with them should submit those agreements. At a minimum, the agreement must identify the parties involved; describe the specific roles and responsibilities of each party; include a summary of the essential terms of the agreement; and be signed and dated by the parties involved.

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1, Required Application ComponentsAppendix B – Guidance for Electronic Submission of Applications.) • Applicants for this program are required to complete the Assurance of Compliance with SAMHSA Charitable Choice Statutes and Regulations Form SMA 170. This form is posted on SAMHSA’s website at xxxx://xxx.xxxxxx.xxx/grants/applying/forms-resources. • Attachments 1 through 4 14 – Use only the attachments listed below. Attachments 1-6 are required. Attachments 7-14 are based on your program design, use of EHRs, and selection of infrastructure activities in Section I.2. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments 2Attachments. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. o Attachment 1: (1) Identification of at least one experienced, licensed mental health/behavioral health services treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; (3) letters of commitment from these direct service provider organizations. Do not include any letters of support. Reviewers will not consider them if you do. (4) the Statement of Assurance (provided in Appendix B II of this announcement) signed by the authorized representative Authorized Representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers involved with the project will meet the two2-year experience requirement, and are appropriately licensed, accredited accredited, and certified; 2) Applicant Self-Assessment Tool provided in Appendix V of this announcement; your application will be screened out and will not be reviewed if the Applicant Self-Assessment Tool is not included in Attachment I; and 3) Identification of other organization(s) that will participate in the proposed project, including a description of their roles and responsibilities and letters of commitment from these organizations. o Attachment 2: Written agreement of the Interagency Council. The written agreement must: identify the parties involved in the Council, describe the specific roles and responsibilities of each party, include a summary of the essential terms of the agreement, discuss the Council’s operating procedures, and be signed and dated by the Council’s Lead. The written agreement must be accompanied by: a roster of the Council members that if identifies the application is within the funding range for an awardagency/system that they represent and letters of commitment from, at a minimum, the applicant will send the GPO the required documentation within the specified timesix previously named key collaborating agencies/systems (i.e., State Medicaid Agency, State Health Department, education, criminal/juvenile justice, mental health, and child welfare). o Attachment 23: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 23. o Attachment 34: Sample Consent Forms o Attachment 5: Financial map of financial resources expended in FY 2011 or later for services for SUD and/or co-occurring substance use and mental disorders (e.g., screening, assessment, treatment, continuing care, recovery support services) for the population of focus. At a minimum, the financial map must consist of tables which: 1) identify screening, assessment, treatment services and recovery supports needed for a comprehensive continuum of services for adolescents and/or transitional age youth with SUD and/or substance use and co-occurring mental health disorders; 2) identify the federal and state funding sources supporting the provision of these services in a specific fiscal year; 3) identify the federal, state, and aggregate amounts spent from each funding source by service in a specific fiscal year; and 4) identify the number of unique users served through the expenditures in a specific fiscal year, where possible. The tables must be accompanied by service definitions, an acronyms table, and a narrative analyzing findings of the mapping exercise complemented with charts and graphs. o Attachment 6: Letter Workforce Training Implementation Plan - 2013-2015 state-/territorial-/tribal-wide multi-year workforce training implementation plan to provide training in the evidence-based assessment and treatment model as well as training in content and skills related to SUD treatment (e.g., child development, trauma focused treatment, neuroscience) to the SSA specialty adolescent and/or transitional age youth behavioral health (if SUD and/or co-occurring substance use and mental disorder) treatment and recovery workforce. The plan must also include training staff in other agencies serving adolescents and transitional aged youth including primary care on SUD related content (e.g., symptoms of SUD, screening, referral). o Attachment 7: Sustainability Plan - 2015-2017 sustainability plan, which at a minimum, is time framed and discusses key activities, milestones, and responsible staff for implementing the activities encompassed in this project. o Attachment 8: If applicable; see PART II, applicants that select both populations of focus and the responsible lead is housed in two separate entities within the state/territory/tribe, the two entities must collaborate in determining which entity will be the applicant. The two entities must collaborate in carrying out the award requirements, as demonstrated by the submission of signed and dated documentation of each entity’s roles and responsibilities in Attachment 8. o Attachment 9: Appendix BIf applicable, Intergovernmental Review (E.O. 12372) Requirements)applicants that have the State Adolescent Treatment/Youth Coordinator selected at the time of application should include his/her résumé and an employment contract.

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1Section II-3.1, Required Application Components.) Applicants for this program are required to complete the Assurance of Compliance with SAMHSA Charitable Choice Statutes and Regulations Form SMA 170. This form is posted on SAMHSA’s website at xxxx://xxx.xxxxxx.xxx/grants/applying/forms-resources. Attachments 1 through 4 14 – Use only the attachments listed below. Attachments 1-6 are required. Attachments 7-14 are based on your program design, use of EHRs, and selection of infrastructure activities in Section I.2. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments 2Attachments. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. Attachment 1: (1) Identification of at least one experienced, licensed mental health/behavioral health services treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; (3) letters of commitment from these direct service provider organizations. Do not include any letters of support. Reviewers will not consider them if you do. (4) the Statement of Assurance (provided in Appendix B of this announcement) signed by the authorized representative Authorized Representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers involved with the project will meet the two2-year experience requirement, and are appropriately licensed, accredited accredited, and certified, ; 2) Applicant Self-Assessment Tool provided in Appendix E of this announcement; your application will be screened out and that will not be reviewed if the application Applicant Self-Assessment Tool is within not included in Attachment 1; and 3) Identification of other organization(s) that will participate in the funding range for an awardproposed project, the applicant will send the GPO the required documentation within the specified timeincluding a description of their roles and responsibilities and letters of commitment from these organizations. Attachment 2: Written agreement of the Interagency Council. The written agreement must: identify the parties involved in the Council, describe the specific roles and responsibilities of each party, include a summary of the essential terms of the agreement, discuss the Council’s operating procedures, and be signed and dated by the Council’s Lead. The written agreement must be accompanied by: a roster of the Council members that identifies the agency/system that they represent and letters of commitment from, at a minimum, the six previously named key collaborating agencies/systems (i.e., State Medicaid Agency, State Health Department, education, criminal/juvenile justice, mental health, and child welfare). Attachment 3: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 23. Attachment 34: Sample Consent Forms Forms. Attachment 5: Financial map of financial resources expended in FY 2011 or later for services for SUD and/or co-occurring substance use and mental disorders (e.g., screening, assessment, treatment, continuing care, recovery support services) for the population of focus. At a minimum, the financial map must consist of tables which: 1) identify screening, assessment, treatment services, and recovery supports needed for a comprehensive continuum of services for adolescents and/or transitional age youth with SUD and/or substance use and co-occurring mental health disorders; 2) identify the federal and state funding sources supporting the provision of these services in a specific fiscal year; 3) identify the federal, state, and aggregate amounts spent from each funding source by service in a specific fiscal year; and 4: Letter to ) identify the SSA (if applicable; see PART II: Appendix Bnumber of unique users served through the expenditures in a specific fiscal year, Intergovernmental Review (E.O. 12372) Requirements)where possible. The tables must be accompanied by service definitions, an acronyms table, and a narrative analyzing findings of the mapping exercise complemented with charts and graphs.

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1, Required Application ComponentsAppendix B – Guidance for Electronic Submission of Applications.) Applicants for this program are required to complete the Assurance of Compliance with SAMHSA Charitable Choice Statutes and Regulations Form SMA 170. This form is posted on SAMHSA’s website at xxxx://xxx.xxxxxx.xxx/grants/applying/forms-resources. Attachments 1 through 4 5 – Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 3, and 4 combined. There are no page limitations for Attachments 22 and 5. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. Attachment 1: (1) Identification of at least one experienced, licensed mental health/behavioral health services substance abuse treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; (3) letters of commitment from these direct service provider organizations. organizations (Do not include any letters of support. Reviewers will not consider them if you do. .); (4) the Statement of Assurance (provided in Appendix B II of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that that: a) all listed providers meet the two-year experience requirement, are appropriately licensed, accredited and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time; b) the availability of permanent housing units match the number of individuals to be served in the grant project for each year of the grant; and c) provider treatment organizations are qualified to receive third party reimbursements or have established links to other organizations with existing third party reimbursement systems. Attachment 2: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. Attachment 3: Sample Consent Forms Attachment 4: Letter to the SSA (if applicable; see PART II: Appendix B, C – Intergovernmental Review (E.O. 12372) Requirements).

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1Section II-3.1, Required Application Components.) • Attachments 1 through 4 5 – Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments 22 and 5. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. o Attachment 1: (1) Identification of at least one experienced, licensed mental health/behavioral health services substance abuse treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; (3) letters of commitment from these direct service provider organizations. ; (Do not include any letters of support. Reviewers will not consider them if you do. .) (4) the Statement of Assurance (provided in Appendix B of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers meet the two-year experience requirement, are appropriately licensed, accredited and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time. o Attachment 2: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. o Attachment 3: Sample Consent Forms o Attachment 4: Letter to the SSA (if applicable; see PART II: Appendix B, Intergovernmental Review (E.O. 12372) Requirements).

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1Section II-3.1, Required Application Components.) Attachments 1 through 4 5– Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments 22 and 5. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. Attachment 1: (1) Identification of at least one experienced, licensed mental health/behavioral health services treatment experienced substance misuse prevention provider organization; (2) a list of all direct service provider organizations that have agreed to participate in the proposed project, including the applicant agency, agency if it is a treatment or prevention service provider organization; (3) letters of commitment from these direct service provider organizations. ; (Do not include any letters of support. Reviewers will not consider them if you do. .) (4) the Statement of Assurance (provided in Appendix B of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers meet the two-year experience requirement, are appropriately licensed, accredited and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time. Attachment 2: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. Attachment 3: Sample Consent Forms Attachment 4: Letter to the SSA (if applicable; see PART II: Appendix B, Intergovernmental Review (E.O. 12372) Requirements).

Budget Justification and Narrative. The budget justification and narrative must be submitted as file entitled BNF (Budget Narrative Form) when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1Appendix A, 3.1, Required Application Components.) Note that all travel for this program both internationally and regionally must be funded out of grants funds. There are no other travel funds available from SAMHSA for this program. Attachments 1 through 4 5 – Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments 22 and 5. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label Label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. Attachment 1: (1Letters of Commitment from any organization(s) Identification of at least one experienced, licensed mental health/behavioral health services treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate participating in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; . (3) letters of commitment from these direct service provider organizations. Do not include any letters of support. Reviewers will not consider them if you do. (4.) the Statement of Assurance (provided in Appendix B of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers meet the two-year experience requirement, are appropriately licensed, accredited and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time. Attachment 2: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. Attachment 3: Sample Consent Forms Attachment 4: Letter Response to Appendix C – Confidentiality and SAMHSA Participant Protection/Human Subjects Guidelines Attachment 5: Certificate of Eligibility (Appendix J) – Must be included or the SSA (if applicable; see PART II: Appendix B, Intergovernmental Review (E.O. 12372) Requirements)application will be screened out and will not be reviewed.

Budget Justification and Narrative. The budget justification and narrative must be submitted as file BNF when you submit your application into Xxxxxx.xxx. (See PART II: SectionII-3.1, Required Application ComponentsAppendix B – Guidance for Electronic Submission of Applications.) Applicants for this program are required to complete the Assurance of Compliance with SAMHSA Charitable Choice Statutes and Regulations Form SMA 170. This form is posted on SAMHSA’s website at xxxx://xxx.xxxxxx.xxx/grants/applying/forms-resources. Attachments 1 through 4 14 – Use only the attachments listed below. Attachments 1-6 are required. Attachments 7-14 are based on your program design, use of EHRs, and selection of infrastructure activities in Section I.2. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments 2Attachments. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label the attachments as: Attachment 1, Attachment 2, etc. Use the Other Attachments Form from Xxxxxx.xxx to upload the attachments. Attachment 1: (1) Identification of at least one experienced, licensed mental health/behavioral health services treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; (3) letters of commitment from these direct service provider organizations. Do not include any letters of support. Reviewers will not consider them if you do. (4) the Statement of Assurance (provided in Appendix B II of this announcement) signed by the authorized representative Authorized Representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA XXXXXX that all listed providers involved with the project will meet the two2-year experience requirement, and are appropriately licensed, accredited accredited, and certified, ; 2) Applicant Self-Assessment Tool provided in Appendix V of this announcement; your application will be screened out and that will not be reviewed if the application Applicant Self-Assessment Tool is within not included in Attachment I; and 3) Identification of other organization(s) that will participate in the funding range for an awardproposed project, the applicant will send the GPO the required documentation within the specified timeincluding a description of their roles and responsibilities and letters of commitment from these organizations. Attachment 2: Written agreement of the Interagency Council. The written agreement must: identify the parties involved in the Council, describe the specific roles and responsibilities of each party, include a summary of the essential terms of the agreement, discuss the Council’s operating procedures, and be signed and dated by the Council’s Lead. The written agreement must be accompanied by: a roster of the Council members that identifies the agency/system that they represent and letters of commitment from, at a minimum, the six previously named key collaborating agencies/systems (i.e., State Medicaid Agency, State Health Department, education, criminal/juvenile justice, mental health, and child welfare). Attachment 3: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 23. Attachment 34: Sample Consent Forms Attachment 5: Financial map of financial resources expended in FY 2011 or later for services for SUD and/or co-occurring substance use and mental disorders (e.g., screening, assessment, treatment, continuing care, recovery support services) for the population of focus. At a minimum, the financial map must consist of tables which: 1) identify screening, assessment, treatment services and recovery supports needed for a comprehensive continuum of services for adolescents and/or transitional age youth with SUD and/or substance use and co-occurring mental health disorders; 2) identify the federal and state funding sources supporting the provision of these services in a specific fiscal year; 3) identify the federal, state, and aggregate amounts spent from each funding source by service in a specific fiscal year; and 4) identify the number of unique users served through the expenditures in a specific fiscal year, where possible. The tables must be accompanied by service definitions, an acronyms table, and a narrative analyzing findings of the mapping exercise complemented with charts and graphs. Attachment 6: Letter Workforce Training Implementation Plan - 2013-2015 state-/territorial-/tribal-wide multi-year workforce training implementation plan to provide training in the evidence-based assessment and treatment model as well as training in content and skills related to SUD treatment (e.g., child development, trauma focused treatment, neuroscience) to the SSA specialty adolescent and/or transitional age youth behavioral health (if applicable; see PART II: Appendix BSUD and/or co-occurring substance use and mental disorder) treatment and recovery workforce. The plan must also include training staff in other agencies serving adolescents and transitional aged youth including primary care on SUD related content (e.g., Intergovernmental Review (E.O. 12372) Requirementssymptoms of SUD, screening, referral).

Budget Justification and Narrative. The budget justification and narrative must be submitted as a file entitled BNF (Budget Narrative Form) when you submit your application into Xxxxxx.xxx. (See PART IIAppendix A: SectionII-3.1, 3.1 Required Application Components.) • Attachments 1 through 4 5 – Use only the attachments listed below. If your application includes any attachments not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Attachments 1, 3 and 4 combined. There are no page limitations for Attachments 22 and 5. Do not use attachments to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Please label Label the attachments as: Attachment 1, Attachment 2, etc. (Use the Other Attachments Form from if applying with Xxxxxx.xxx Workspace to upload the attachmentsattachments or Other Narrative Attachments if applying with eRA ASSIST.). o Attachment 1: (1Letters of Commitment from any organization(s) Identification of at least one experienced, licensed mental health/behavioral health services treatment provider organization; (2) a list of all direct service provider organizations that have agreed to participate participating in the proposed project, including the applicant agency, if it is a treatment or prevention service provider organization; . (3) letters of commitment from these direct service provider organizations. Do not include any letters of support. Reviewers will not consider them if you do. (4.) the Statement of Assurance (provided in Appendix B of this announcement) signed by the authorized representative of the applicant organization identified on the first page (SF-424) of the application, that assures SAMHSA that all listed providers meet the two-year experience requirement, are appropriately licensed, accredited and certified, and that if the application is within the funding range for an award, the applicant will send the GPO the required documentation within the specified time. o Attachment 2: Data Collection Instruments/Interview Protocols – if you are using standardized data collection instruments/interview protocols, you do not need to include these in your application. Instead, provide a web link to the appropriate instrument/protocol. If the data collection instrument(s) or interview protocol(s) is/are not standardized, you must include a copy in Attachment 2. o Attachment 3: Sample Consent Forms o Attachment 4: Letter to the SSA (if applicable; see PART II: Appendix BI, Intergovernmental Review (E.O. 12372) Requirements). o Attachment 5: Response to Appendix C - Confidentiality and SAMHSA Participant Protection/Human Subjects Guidelines. This is a required attachment.